• 四川大學(xué)華西醫(yī)院（成都，610041）1手術(shù)室，2骨科;

目的探討頸椎間盤置換術(shù)（cervical disc replacement，CDR）術(shù)中體位與術(shù)后早期頸椎中立位生理軸線重建的相關(guān)性。 方法回顧性分析2008年1月－2010年8月51例采用PRESTIGE LP椎間盤假體行單節(jié)段CDR患者的臨床資料，術(shù)中患者取仰臥位，頸枕置于頸后部維持頸椎前弓。男28例，女23例；年齡30～64歲，平均45歲。其中脊髓型頸椎病32例，神經(jīng)根型頸椎病7例，混合型頸椎病12例。病程3～48個月，平均15個月。手術(shù)節(jié)段：C4、5 5 例，C5、6 42例，C6、7 4例。收集患者術(shù)前、術(shù)中及術(shù)后3個月頸椎中立位、側(cè)位X線片，分別測量頸椎整體序列（C2～7）、目標(biāo)脊柱功能單位（functional spinal unit，F(xiàn)SU）及目標(biāo)椎間隙的Cobb角。計算術(shù)中與術(shù)前的角度差（差值）及術(shù)后早期（3個月）與術(shù)前的角度差（改善值），對不同平面Cobb角差值和改善值進(jìn)行線性相關(guān)及線性回歸分析。結(jié)果與術(shù)前相比，術(shù)中及術(shù)后3個月時頸椎Cobb角均顯著增大（P  lt; 0.05）。其中頸椎整體序列、目標(biāo)FSU及目標(biāo)椎間隙的Cobb角差值分別為（6.72 ± 9.13）、（2.10 ± 5.12）、（3.33 ± 3.75）°；術(shù)后3個月Cobb角的改善值分別為（6.30 ± 7.28）、（3.99 ± 5.37）、（4.29 ± 5.36）°。目標(biāo)FSU的Cobb角改善值與目標(biāo)椎間隙Cobb角改善值比較差異無統(tǒng)計學(xué)意義（t= —0.391，P=0.698），與頸椎整體序列Cobb角改善值比較差異有統(tǒng)計學(xué)意義（t= —2.623，P=0.012）；目標(biāo)椎間隙角度改善與整體序列角度改善比較差異無統(tǒng)計學(xué)意義（t= —1.917，P=0.061）。頸椎整體序列、目標(biāo)FSU、目標(biāo)椎間隙的術(shù)中頸椎Cobb角差值與術(shù)后早期頸椎Cobb角改善值3對變量之間均存在線性相關(guān)及線性回歸關(guān)系（P  lt; 0.05）。結(jié)論CDR術(shù)中頸椎位置保持在較術(shù)前中立位輕度后伸的位置是術(shù)后早期頸椎維持正常生理前凸的一個重要因素。

引用本文： 洪瑛,鄧宇驍,劉浩,龔仁蓉,安晶晶,龔全,李濤,宋躍明. 單節(jié)段頸椎間盤置換術(shù)中頸椎體位對術(shù)后頸椎中立位生理軸線重建的影響. 中國修復(fù)重建外科雜志, 2013, 27(1): 62-65. doi: 復(fù)制

1. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am), 1958, 40-A(3): 607-624.
2. Chang UK, Kim DH, Lee MC, et al. Range of motion change after cervical arthroplasty with ProDisc-C and prestige artificial discs compared with anterior cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 40-46.
3. 唐文, 劉志禮, 舒勇. 頸椎間盤置換與頸前路椎間盤切除減壓植骨融合治療退變性頸椎病的Meta分析. 中國組織工程研究與臨床康復(fù), 2010, 14(4): 615-620.
4. Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacent segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine, 2005, 3(6): 417-423.
5. Peng CW, Yue WM, Basit A, et al. Intermediate results of the prestige LP cervical disc replacement: clinical and radiological analysis with minimum two-year follow-up. Spine (Phila Pa 1976), 2011, 36(2): E105-111.
6. Sasso RC, Metcalf NH, Hipp JA, et al. Sagittal alignment after bryan cervical arthroplasty. Spine (Phila Pa 1976), 2011, 36(13): 991-996.
7. Wang MY, Leung CH, Casey AT. Cervical arthroplasty with the Bryan disc. Neurosurgery, 2005, 56(1 Suppl): 58-65.
8. Yanbin Z, Yu S, Zhongqing C, et al. Sagittal alignment comparison of Bryan disc arthroplasty with ProDisc-C arthroplasty: a prospective, randomized controlled clinical trial. J Spinal Disord Tech, 2011, 24(6): 381-385.
9. Walraevens JR, Liu B, Sloten JV, et al. Postoperative segmental malalignment after surgery with the Bryan cervical disc prosthesis: is it related to the mechanics and design of the prosthesis? J Spinal Disord Tech, 2010, 23(6): 372-376.
10. 蔣濤, 任先軍, 王衛(wèi)東, 等. 人工頸椎間盤置換對鄰近節(jié)段椎間盤的保護(hù)作用. 中國矯形外科雜志, 2010, 18(7): 529-533.
11. Ahn PG, Kim KN, Moon SW, et al. Changes in cervical range of motion and sagittal alignment in early and late phases after total disc replacement: radiographic follow-up exceeding 2 years. J Neurosurg Spine, 2009, 11(6): 688-695.
12. Anakwenze OA, Auerbach JD, Milby AH, et al. Sagittal cervical alignment after cervical disc arthroplasty and anterior cervical discectomy and fusion: results of a prospective, randomized, controlled trial. Spine (Phila Pa 1976), 2009, 34(19): 2001-2007.
13. Shim CS, Lee SH, Park HJ, et al. Early clinical and radiologic outcomes of cervical arthroplasty with Bryan Cervical Disc prosthesis. J Spinal Disord Tech, 2006, 19(7): 465-470.
14. Schmidt R, Obertacke U, Nothwang J, et al. The impact of implantation technique on frontal and sagittal alignment in total lumbar disc replacement: a comparison of anterior versus oblique implantation. Eur Spine J, 2010, 19(9): 1534-1539.
15. Johnson JP, Lauryssen C, Cambron HO, et al. Sagittal alignment and the Bryan cervical artificial disc. Neurosurg Focus, 2004, 17(6): E14.
16. 王林, 雷偉, 桑宏勛, 等. Prestige LP頸椎椎間盤置換術(shù)后“張口不良”原因分析. 脊柱外科雜志, 2011, 9(5): 302-306.
17. Miyazaki M, Hymanson HJ, Morishita Y, et al. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976), 2008, 33(23): E870-876.
18. Galbusera F, Bellini CM, Brayda-Bruno M, et al. Biomechanical studies on cervical total disc arthroplasty: a literature review. Clin Biomech (Bristol, Avon), 2008, 23(9): 1095-1104.
19. Yi S, Shin HC, Kim KN, et al. Modified techniques to prevent sagittal imbalance after cervical arthroplasty. Spine (Phila Pa 1976), 2007, 32(18): 1986-1991.
20. 劉文華, 朱兵, 劉曉偉, 等. 單節(jié)段Bryan 人工頸椎間盤置換術(shù)后異位骨化的發(fā)生率和療效觀察. 中國修復(fù)重建外科雜志, 2012, 26(6): 699-702.
  1. 1. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am), 1958, 40-A(3): 607-624.
  2. 2. Chang UK, Kim DH, Lee MC, et al. Range of motion change after cervical arthroplasty with ProDisc-C and prestige artificial discs compared with anterior cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 40-46.
  3. 3. 唐文, 劉志禮, 舒勇. 頸椎間盤置換與頸前路椎間盤切除減壓植骨融合治療退變性頸椎病的Meta分析. 中國組織工程研究與臨床康復(fù), 2010, 14(4): 615-620.
  4. 4. Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacent segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine, 2005, 3(6): 417-423.
  5. 5. Peng CW, Yue WM, Basit A, et al. Intermediate results of the prestige LP cervical disc replacement: clinical and radiological analysis with minimum two-year follow-up. Spine (Phila Pa 1976), 2011, 36(2): E105-111.
  6. 6. Sasso RC, Metcalf NH, Hipp JA, et al. Sagittal alignment after bryan cervical arthroplasty. Spine (Phila Pa 1976), 2011, 36(13): 991-996.
  7. 7. Wang MY, Leung CH, Casey AT. Cervical arthroplasty with the Bryan disc. Neurosurgery, 2005, 56(1 Suppl): 58-65.
  8. 8. Yanbin Z, Yu S, Zhongqing C, et al. Sagittal alignment comparison of Bryan disc arthroplasty with ProDisc-C arthroplasty: a prospective, randomized controlled clinical trial. J Spinal Disord Tech, 2011, 24(6): 381-385.
  9. 9. Walraevens JR, Liu B, Sloten JV, et al. Postoperative segmental malalignment after surgery with the Bryan cervical disc prosthesis: is it related to the mechanics and design of the prosthesis? J Spinal Disord Tech, 2010, 23(6): 372-376.
  10. 10. 蔣濤, 任先軍, 王衛(wèi)東, 等. 人工頸椎間盤置換對鄰近節(jié)段椎間盤的保護(hù)作用. 中國矯形外科雜志, 2010, 18(7): 529-533.
  11. 11. Ahn PG, Kim KN, Moon SW, et al. Changes in cervical range of motion and sagittal alignment in early and late phases after total disc replacement: radiographic follow-up exceeding 2 years. J Neurosurg Spine, 2009, 11(6): 688-695.
  12. 12. Anakwenze OA, Auerbach JD, Milby AH, et al. Sagittal cervical alignment after cervical disc arthroplasty and anterior cervical discectomy and fusion: results of a prospective, randomized, controlled trial. Spine (Phila Pa 1976), 2009, 34(19): 2001-2007.
  13. 13. Shim CS, Lee SH, Park HJ, et al. Early clinical and radiologic outcomes of cervical arthroplasty with Bryan Cervical Disc prosthesis. J Spinal Disord Tech, 2006, 19(7): 465-470.
  14. 14. Schmidt R, Obertacke U, Nothwang J, et al. The impact of implantation technique on frontal and sagittal alignment in total lumbar disc replacement: a comparison of anterior versus oblique implantation. Eur Spine J, 2010, 19(9): 1534-1539.
  15. 15. Johnson JP, Lauryssen C, Cambron HO, et al. Sagittal alignment and the Bryan cervical artificial disc. Neurosurg Focus, 2004, 17(6): E14.
  16. 16. 王林, 雷偉, 桑宏勛, 等. Prestige LP頸椎椎間盤置換術(shù)后“張口不良”原因分析. 脊柱外科雜志, 2011, 9(5): 302-306.
  17. 17. Miyazaki M, Hymanson HJ, Morishita Y, et al. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976), 2008, 33(23): E870-876.
  18. 18. Galbusera F, Bellini CM, Brayda-Bruno M, et al. Biomechanical studies on cervical total disc arthroplasty: a literature review. Clin Biomech (Bristol, Avon), 2008, 23(9): 1095-1104.
  19. 19. Yi S, Shin HC, Kim KN, et al. Modified techniques to prevent sagittal imbalance after cervical arthroplasty. Spine (Phila Pa 1976), 2007, 32(18): 1986-1991.
  20. 20. 劉文華, 朱兵, 劉曉偉, 等. 單節(jié)段Bryan 人工頸椎間盤置換術(shù)后異位骨化的發(fā)生率和療效觀察. 中國修復(fù)重建外科雜志, 2012, 26(6): 699-702.